Untangled Mind™, LLC hosted by Piper Harris
Untangled Mind™, LLC hosted by Piper Harris
S6 Ep 52: Feigning in Therapy – The Unspoken Challenge
Use Left/Right to seek, Home/End to jump to start or end. Hold shift to jump forward or backward.
Untangling the Truth: Feigning in Therapy & Why It Matters
Welcome to The Untangled Mind Podcast! In this episode, I’m tackling a topic that most therapists avoid—feigning in therapy. What happens when clients exaggerate or even fabricate symptoms, whether consciously or unconsciously? And why do so many in the industry refuse to address this?
As a data-driven therapist specializing in anxiety, trauma, and grief, I believe therapy should challenge distorted beliefs, not just affirm distress. In this episode, I break down:
🔹 What feigning in therapy looks like—malingering, factitious disorders, and unconscious symptom exaggeration
🔹 The impact of unchecked validation vs. actual therapeutic growth
🔹 Why some clients receive confrontation well while others blame and attack
🔹 The role of diagnostic tools—how they should inform treatment, not pathologize
🔹 Why therapists need to stop fearing client reactions and stand firm in ethical practice
🚨 Therapists – Are you avoiding these hard conversations because of how clients might react?
🚨 Clients – Are you using therapy as a tool for change, or a shield from discomfort?
True healing requires accountability, not just affirmation. Let’s cut through the mental clutter and get real about what therapy should be.
🔗 Read the full blog post: Feigning in Therapy: The Unspoken Challenge
👍 Like, Subscribe, & Share if you found this episode valuable.
🗨 Drop a comment – What are your thoughts on feigning in therapy? Should therapists challenge clients more?
📍 Follow me for more insights:
🌐 Website: www.untangledmind.net
📷 Instagram: @untangledmindllc
📘 Facebook: @untangledmindllc
💼 LinkedIn: @utangledmindllc
#FeigningInTherapy #TherapistTalks #CBTPodcast #UntangledMind #MentalHealthMyths #CognitiveBehavioralTherapy #NoNonsenseTherapy #TraumaTherapy #untangledmindllc
Hi there, I'm Piper Harris, and welcome to season six of the Untangled Mind Podcast, where we cut through the mental clutter to help you untangle life's toughest challenges. I'm a data-driven mental health therapist in the suburbs of Atlanta, Georgia, specializing in trauma, anxiety, and grief. Using third-wave, CBT, and neuropsychological applications, I offer practical, no-nonsense tools to untangle your mind and take meaningful action. On today's episode, we're tackling a tough but necessary conversation: feigning in therapy, the unspoken challenges we see with this. Therapy has become a space of unchecked validation, but is that truly helping clients heal? What happens when therapists ignore the possibility of feigned symptoms, whether intentional or not? And why do so many in the industry avoid this discussion altogether? Today we're diving into the reality of feigning, how it presents in therapy, the ethical implications of ignoring it, and why true empathy sometimes requires direct confrontation rather than endless affirmation. If you're a clinician, this episode will challenge you to reconsider how you approach difficult conversations in therapy. And if you're a client, this will help you reflect on whether therapy is genuinely serving your growth or simply reinforcing your distress. Thanks for joining me on the Untangled Mind Podcast. Let's get to it. Hello, hello. Welcome to the Untangled Mind Podcast. I am Piper. So I'm kind of curious if this introduction either really intrigued you and piqued your interest or if it irritated you. So let's get to the topic. And it really started off with something that I'm seeing in the therapy room. It's really interesting the other day. I read a post from a therapist, and I think she was kind of writing it to kind of a clickbaity post, I guess you would say. But what she was saying is that she thought it was unethical to use client examples in everyday teaching, which I completely disagree with. You know, we take out the client um, you know, determinants of like who they are, you know, anything that's identifiable. And so, granted, if a client reads a blog or listens to a podcast, they might say, oh my gosh, they're talking about me. But what I want to say with this conversation is that my clients teach me every single day. And a lot of times this uh really expands my growth as a clinician, and I'm very grateful for it. Sometimes they teach me about client populations that I absolutely don't want to work in. Um, but again, I think that we live by by looking and watching individuals. We learn, we grow by watching and learning from examples. And so that's why I think that it's very important for us to bring client examples to the forefront to have this discussion. Because here's the thing that sometimes maybe a clinician will say, Oh my gosh, that's me. I'm not alone, alone in this. Or it could potentially be an individual that's say listening to this podcast and really makes them reflect and go, gosh, I really didn't consider this. So again, um, kind of going back to when I read this post by this counselor, I don't think this is unethical. I'm not, you know, adding any client identifiers in the conversation, but it is a very important conversation for us to have. And again, this is about learning. This is not about um attacking anybody, but this is about having an honest, direct conversation, whether it be about client behaviors or it might be about clinician behaviors. So, what I'm talking about today is feigning in therapy. And so um there's two different types of feigning. There is malingering, and this is when somebody deliberately exaggerates or fabricates something for external gain. Okay. Then there's fictitious disorder, and this is when um someone typically assumes a sick role to receive some sort of validation. Now, I also think there's a third kind of feigning, and this is an unconscious driver. I really think that these are clients who adopt symptoms without awareness, and it's often influenced by societal narratives or even environmental drivers. So I really want to talk about that. So, in particular, why this came to mind is that I've been working with an individual that came to me with um supposed, I'll say supposed, um, or I'll say perceived, supposed is not the best word, but perceived high levels of anxiety. So talking to this individual and they um presented with very high levels with of anxiety. But then, as all of you know, I'm data driven. I'm sending multiple assessments. Right now, I currently have 17 in rotation. Um, and the reason I do this is to validate what I'm seeing with the client, to um see if I'm seeing any inconsistencies and so that I'm aware. I was um working with a gal that I'm mentoring right now. Shout out to Felicia, love her, we're having so much fun, but we were discussing that she is learning in schooling that you know, um people say assessments are bad and that it takes away the empathy of the client or of the count the counselor. And what I told her is that we utilize assessments to inform treatment. We do not utilize assessments to pathologize the client. So when I use multiple assessments, this is allowing me to look at here is the intake information, this is the information they gave me or the consultation interview before coming on with me. Here's what they say their pain points are, here are what the assessments tell me, and this is the story that I'm seeing unfold in front of me. How do I inform my treatment based on all of these things? So when it comes to people that say that assessments are bad, I disagree. It's how you use them. So, all that to be said, this um individual came to me with perceived high levels of anxiety. Well, what happened though is none of my assessments showed high levels of anxiety. I mean, absolutely none of them. And again, I'm I'm it's 17 assessments, a 17. The only one that showed a higher level of anxiety is the PID five. So a lot of times clinicians use the PID five to inform if there's a personality disorder. Now, granted, this is helpful for me because if I see someone that has got has high levels of psychoticism, I this is not my area of expertise. I refer them out, but truly what I use a PID for is showing the clients these are representative of aspects of your personality. They come out when you're highly distressed. Now, with this individual, it did show higher levels of anxiety, but that was it. And that was in a personality disorder assessment. So, what does that tell me? When the GAD 7 doesn't show me anxiety, the DASS 21 doesn't show me anxiety, when her satisfaction with life scale is very high, what is this story telling me? I don't understand. So as I got to know this individual, we discussed my approach to high anxiety levels because um they had related that they had pretty severe anxiety when it came to social interactions, whether that be, you know, going to doctor's appointments, going to the grocery store, whatever it is. And so this individual really talked about this is so painful for me, this is very difficult. They also uh related that they have intense somatic symptoms. So every time they perceived a somatic pain, they would then perceive, oh my gosh, I'm anxious. So I'm what I'm starting to see is they feel something somatically, they interpret it as high levels of anxiety, that high level anxiety leads them to a behavior of avoiding social interactions. So I explained to this individual that our course of treatment was, of course, to start with my pyramid approach. We always start at the bottom. We're making sure that health indicators are okay. So this is like, what are your doctors saying? Are you working with a psychiatrist? When was your last blood panel? Let's make sure all of those things are in our order and we're not looking at something else that could be in increasing, whether it's somatic symptoms or the anxious symptoms. Then from there we go into regulation strategies. And typically any person I work with here, if they've got really mild levels of distress, we might spend one to two sessions on regulation strategies. So this is me teaching them about what's happening with their brain, what's happening with their body, how to work on vagal tone. So that vagus nerve activating that, explaining why this is taking place. Then from there we go into attachment work. We're talking about how our attachment stylings and our attachment figures often determine how we relate in personal relationships. This is not about blaming our parents, but this is about mindfulness about behaviors that um we've uh, you know, committed to, I guess you could say, from a very young age and continue throughout life. Then, then, if I'm working with an individual that has high levels of anxiety or trauma or even grief, that's when potentially I go into exposure therapy. And so the reason why exposure therapy is so important when it comes to the application of CBT, the exposure part is the B in the CBT. That's the behavioral part. And so what we do in exposure therapy is we expose the individual to those feared stimulus so that they no longer are felt or are feeling, excuse me, paralyzed by that feared stimulus. So I'm working with this individual. We work through the pyramid. I'm seeing amazing outcomes with the application of vagal activation, and they created their own toolbox that's just really effective. Um, and it was great. I mean, we're I'm tracking every 30 days, I'm seeing these, you know, basically mild levels of anxiety if they pinged it all down to nothing on assessments. So we're seeing, you know, positive outcomes, and she's expressing in therapy that, oh my gosh, this is amazing. I'm finding these things that work for me, and I'm feeling great, awesome, good. Well, then what happens is that the the conversation starts going to what's my next homework assignment and am I doing okay? So what I initially picked up on was this seeking of validation. And at one particular um session, I said, Hey, did you know that you're seeking validation? This individual said, Well, how am I doing? And I repeated back, how do you think you're doing? And she was able to state back, I'm I'm doing great. I'm I'm following things, I'm feeling better, I'm doing my homework, everything's great. And I said, Did you recognize you're seeking validation when you do know that you're like knocking it out of the park? You're doing really well. Let's be mindful of the seeking of validation because this is about empowering you, not me making you feel better. I'm not serving you by fluffing you. I tell this to my clients all the time. I don't do you any good by coddling behavior that's keeping you in distress. So, anyway, that was the first indication. I thought, huh. So I'm going back to my original history or story that I'm I'm working on assessments, the declared pain points, and what's actually going on. So I'm really keeping this at the forefront of my mind. And so what happens then? I was like, okay, we're gonna see what's going on with this. And I say, well, let's create um your idea, your hierarchy of fear. So a lot of times with exposure, we create a hierarchy of fear. So we say, what are your fearful things that you're approaching? And we're gonna scale them on a scale of zero to 100 or zero to 10. Essentially, it's a sud scale, subjective unit of distress. So, say it's somebody with social anxiety. Um, a two might be, gosh, thinking about going to the grocery store. Uh, a suds level of five, so they're kind of in the middle of distress, it's pretty distressing. It's not terrible, but they can maybe manage at a five, is um, you know, writing my grocery list and getting in the car. Then they might do a suds scale at like a 70%. So we're getting at a pretty high level of distress that we're gonna start seeing breakdown in cognition. We're gonna see that elevation of uh of mygdular activation, so that fight or flight. Um, and so maybe what that is is I have to open the door and go into the grocery store. So this is kind of how a fear hierarchy works. So I stated, okay, your homework is we're gonna create a bag of um, you know, whatever container you want. And I explained that I want your container to be beautiful because the thing is is we fear these things, um, but when we overcome them through exposure, they do become beautiful to us. So I always say when we do this, like find a container for this. So she had this beautiful little bag that she brought it in. And what was interesting about what was found in the bag is that she had um not as many as she thought she needed and very low SUD scores, only got to five. And so this was very telling. And I said, you know, and and then she described um her awesome ability to go and do an event that she perceived as this really scary thing. And it was awesome because I'm I'm talking her through it. Like, are you seeing how capable and how courageous you are? So again, this goes back to you were perceiving this as a threat. And what this is telling me is you do not need exposure. And in fact, exposure would do you harm, not good. So when I share this story, what I'm talking about when it comes to feigning is this is an individual that this is unconscious feigning. This is not somebody that is deliberately looking for um, they're not deliberately uh taking part in illness on purpose. This is really about looking at, okay, what's the client's story? Where are they in their stage of life? Is this about building up their worth, their self-esteem, encouraging more behavioral activation? So encouraging community. So this was a whole different thing, but it really got me thinking about feigning in general. So, what that led me to do is do some research on what are we seeing? What is research really showing us right now on feigning? And what we're seeing is that clinicians as a whole completely overestimate their ability to detect feigning symptoms. And I really think that's because of societal norms and especially what we're seeing right now, um, these cultural shifts like on social media. It's like if you're a clinician and you're abrupt, or if you're confrontational of these are the behavioral patterns and feelings that are keeping you stuck, that we lack empathy, that that we're horrible people. And I think this is wrong. And so clinicians then they're like, oh, I it's it's not, it's, you know, I would know if they're feigning, because really what it is is that they're fearful of if they confront it, if they confront the feigning, what could they be perceived as? It's not even about the client, it's about the clinician. And so it's really interesting when you read the evidence of this. I did write a blog, so you can head on over to untangledmind.net under resources and blog. You'll see uh my my uh blog post on this, so you can read all the research. But it really was interesting. In fact, I ran um into a study um that was back in 2020, and what it was showing is is that clinicians were not paying attention specifically to malingering. And so this is this is deliberate manipulation of the clinician to have this individual's needs met. And it and this was in a psychiatric facility, but very interesting. And what happens is that because they didn't call it out, because they overestimated their ability to see see feigning, and again, I think this is about the clinician's fears. I don't think it has anything about their their ability to call out feigning or not. I think it's actually about their fears. What happened was then these individuals who really were not psychotic were put through very painful treatments, harmful treatments, and it should never have happened. So again, I want to go back to that not all feigning, we're gonna discuss more different types of feigning, but not all clients feign intentionally. So the difference between seeking validation and seeking out actual treatment, there's there's different things there. People may be seeking validation, but it is not in a malicious, um, kind of malignant, evil, you know, thought process. A lot of times I see individuals that are not necessarily feigning, but they're seeking validation because of a specific phase in life, especially people in their retirement years. This is such an enormous change for them that they, their kids are out of the house, maybe a spouse has passed away, and it's like, what's my relevance? What, who am I? What do I do? So they're seeking validation because they are at a loss. And so, as clinicians, when we see that seeking of validation and possibly the amplification of minor symptoms, like a somatic symptom and perceiving it as like this, oh my gosh, this is the highest level of anxiety I've ever felt. We need to ask the really tough questions like, how are you feeling in life right now? Where do you see your worth is? How do you communicate needs? Because ultimately, I think they're seeking validation. This is a really tough stage in life. So then again, we also have to consider that some people are actually seeking treatment. And again, we have to use all the tools in our toolbox to say, is this an actual thing that we need to treat, or is this like a life skill thing and having deliberate conversation? So again, some clients might unconsciously adopt these mental health identities. And oh my gosh, we see this all the time right now. Um, social media, uh it has perpetuated this idea that everybody is broken, everybody's a narcissist, everybody's borderline, everybody's anxious, everybody's depressed. And it's like, stop. Not everybody is one of those things. And I think that social media in particular, and this cultural norm anymore, is that you're not special if you don't have a label. You're not special if you're not so outrageously different from everybody else. And we have got to get away from that. We are not, we are special because we are all individual human beings. You do not need to over-exaggerate self or over-exaggerate distress to be more special. That that's not how you should do this. This is not healthy. This is not coping. And clinicians, you are not helping them by just affirming every thought that comes through their head. That is not why we were put on this earth. So, again, um, going back to people that um, you know, maybe they're seeking um validation or maybe they're actually seeking actual treatment. So another client story had a client, she and I are talking um working on her stuff, and she said, Hey, I'm I found my daughter therapy. And I was like, Okay, well, obviously this is an important discussion. Let's have a conversation. Why? Why did you seek therapy for her? And she just kind of was like, Well, what do you mean? And I'm like, why does she need it? And ultimately I laid out, okay, like, let's look at some symptoms that you could be seeing as mom that really tells you, oh my gosh, my kid needs help. So I'm going through like symptoms like wetting the bed, acting out in school, um, maybe we're seeing picking, maybe we're seeing, you know, fighting, whatever it is. And all of it was, no, my kid's like super awesome and amazing. So this opened a conversation of me saying, okay, then why are you relinquishing your ability to work with your kiddo to a complete stranger? Why is your kiddo in need of therapy? And it really allowed a great conversation about this is about you taking, excuse me, responsibility and ownership of the parental process. It sucks and it's hard. Speaking as a mom, it is one of the hardest jobs I've ever done. But there is a danger, there is a danger in relinquishing control to professionals rather than developing personal coping skills. Do you hear that? There is a danger in you parents relinquishing control to counselors rather than you developing your personal coping skills. And a lot of therapists out there are gonna shake their head and think I'm the worst person possible. But listen, I don't believe there are kiddos that 100% need us. 100%. But often, and this is why I don't work with kids, it is what's happening at home in the environment. So it is the parents that need the counseling, that need the skill development. Parents, please stop relinquishing control to complete strangers. Just because we're experts doesn't mean we're an expert on your kiddo and your relationship. That's what you need to look into and step into. And again, I encourage this client like, listen, you can make your own decisions, but I think you're fully capable of stepping into this. And why give a complete stranger control and um a place in your your kiddo's life? Like that to me sounds dangerous, frankly. And the same thing goes for you. If you're listening, there is a danger in relinquishing all your control to a therapist rather than developing coping skills. Do you hear that? And again, the social norms that we're seeing right now is this affirmation of every single distress on the face of the earth. You guys, life is hard. Life sucks sometimes. Life is tragic and traumatic and painful and ugly and horrifying, but it's also joyful. And sometimes it's just meh, it's just blah. But listen, it doesn't mean that you truly need a professional's help. I think the problem with our industry is that we have taken away the ability to encourage our clients to take control, to have courage, to make change in their lives. Rather, we're like, just come sit on the couch and let's just talk about all the terrible things that are happening in your life and all the terrible people that are in your life. And gosh, yeah, I just feel so sorry for you. And we just sit there and nod our head and they walk away and they just feel like crap because you did nothing. You did nothing for them. Encourage autonomy, encourage independence, encourage courage, but we don't do it. So we need to encourage honest self-assessment. What do I truly need? Now, again, you might not be able to do that. So, for example, the first client I mentioned, this is a wonderful interaction where I am blessed to step in with somebody and say, let me show you what's happening. Let me show you that this perceived anxiety was never there. It's about how you're looking at self, how you believe you're able to cope or not. Let's work on that. That is so incredibly important. And what a blessing for me to be able to have that kind of impact in somebody's life. So let's talk about also the impacts of feigning. Okay, so feigning can impact therapy and clinical practices, definitely. So one of the consequences of ignoring feigning and treatment, so not having a direct conversation with a client about feigning symptoms, is that number one, it's gonna be ineffective therapy because you're not actually treating what's going on. So if they're feigning, say, severe depression, like this one that I was reading, um, the study I was reading early, they were feigning severe depression and psychoticism, feigning it, feigning it. So what happens? The client or the clinician only goes on the feigned symptoms, so they apply ineffective therapeutic tools. Uh, that's not good. So you're not only prolonging their um made-up world, their feigning symptoms, but here's the problem, and clinicians, you've got to hear this is that there is potential harm. And this is something that I talk about with all of my clients at the beginning of every single intake with them, is that it's called, I'm not really good at the word, iatrogenic harm. So this basically is that therapists they reinforce pathology that harms them or they have deliberate tech um therapeutic uh applications that cause them harm rather than maybe addressing core issues. So, for example, if I didn't pay attention to my gut saying, what am I seeing? I'm seeing validation seeking, I'm not seeing any clinical levels of anxious distress. If I had put this client through exposure therapy, what the hell? I am causing her harm. Listen, exposure therapy is not fun. And so if I put this individual through exposure therapy and all of these practices, I increase distress levels. So therefore, maybe those somatic symptoms get worse, or maybe I actually put them into a severe, anxious, um, maybe they're gonna have a panic attack, maybe they get really sick and they actually end up having, you know, some other issues, whatever it is, I could have caused more harm. And that is something that we have got to talk about as clinicians. I talk to every one of my clients. I say to them, and I try to make it funny, but I say, we need to talk about, I obviously love counseling and I believe in the benefits of counseling, but let's talk about that there are sometimes side effects, just like you see on medication commercials to counseling. I said, you know, just like you see on our medication commercials that sometimes it can cause you diarrhea. I say, hopefully I don't cause you diarrhea. But there's actual consequences and they can be harmful to you in counseling, and let's talk about them. We have got to stop falling away from this. Clinicians, you are not superhuman. I am not superhuman. I screw up. In fact, I screwed up with a client the other day, and oh my gosh, I put her through the roof in suds, and I was like, holy crap, this happened way too fast. I felt terrible. And so we had a conversation about it. Like, I am so sorry that I got you such a high level of distress. Let's talk about this. And I recognize that my approach in that certain situation was not the best for you. But I didn't hide from my screw up. I am not superhuman. So, therapists, like you're you're not infallible. We have to talk about this. So if you're deliberately ignoring feigning and not having direct confrontation with the client and still proceeding with a treatment plan and therapeutic approaches that are not applicable to what's actually going on because you're just afraid of how they're going to react. Shame on you. Shame on you. You have ethical responsibility therapists, not just simple, simply validating distress, but guiding clients towards solutions. So if you recognize, I think they're feigning, whether it's conscious or not, you need to call it out. I mean, it's just absurd that we don't do it because we're just so afraid of how the client's gonna react. And listen, this is not always fun. Sometimes the outcomes of confronting a client is not so fun. There's usually two common responses. One is openness and reflection. So this is those clients that recognize deeper issues. So it's a lack of self-worth or loneliness. And so they're willing to work on those areas and we get to walk through them with something that's so life-giving. But then there's others, right? And they're gonna displace and they're gonna attack us. So then there's others that might shift the blame and they become defensive or lash out at therapists. Listen, your client's resistance or retaliation is not a reflection of your professionalism or your perceived lack of empathy. The fearing of the fear of being disliked or harsh should not drive your clinical decisions. And listen, we are not responsible for how our client integrates information. We're not. Our role is to present truth, present challenges and or excuse me, present challenge and challenge distorted thoughts and foster real change with real applicable therapeutic tools to what's going on. And listen, this is where it's so key that clinicians seek out consultation. I have sought out consultation so much this past week because I'm like, okay, I want to make sure, am I seeing this? In fact, I sought out consultation. Like, am I doing a little uh counter-transference here? Am I am I adding some personal overlay on a client issue? Like, I want to make sure that I'm very aware. But listen, you just like we hope our clients are open and reflective, clinicians, you need to do it too. And stop being afraid of being attacked. That is not a representation of what you did. If you do all the right things, see consultation, document the heck out of everything. Um, you have actual treatment plans. Listen, that is about the client. That is about their house of cards that they've created. If they attack you, that's on them. That's not on you. So client resistance or retaliation is not a reflection of your professionalism or empathy. We are not, we are not responsible for how clients integrate the information. It's kind of like this the saying goes, we can only lead a horse to water. Can't make them drink, y'all. We can't. As much as we want them to, we can't force them. So confronting feigning can be a very uncomfortable situation. Confronting clients with any of their behaviors can be very uncomfortable. I've had clients up and leave in the middle of session. I've had them scream at me, and I basically said, You won't do that again or you will not return. Um, you know, it's not fun. But then there's those that we confront, and I've seen it like their face drops and they go, Oh my gosh, I didn't know. And I'm telling you, like I I can literally see faces running through my mind right now. When I see clients have this look of, oh my gosh, I didn't know. And they're so open. They're so open to saying, okay, I want to change this. Oh my gosh, I didn't see that I was doing this. Yes, help me see this, help me change what's taking place. Oh my gosh. That's why confrontation is so key. Because you see the shift, you see the change, and then you know you actually made a difference in their lives. You actually empowered them, you actually encouraged them into autonomy and independence. You actually did your job rather than pat them on the butt and coddle them and just talk about the crappy things in life. You made a difference. So confrontation is so stinking key. Um, finally, I really want to talk about that. There is a role of diagnostic tools when it comes to um feigning. Now, there is a tool, and I can't remember the acronym because I don't use it. Um, let me look it up actually. I'm on my podcast or my blog because I was reading about it earlier because I've never used this tool. I've I I don't like this one for um diagnostic um help. So it's a structured inventory of malingered symptomology. Say that 10 times fast. Um, so the S-I-M-S. Okay, so basically what they found out with this um this assessment is essentially it showed a high rate of false positives. And so it really mislabeled like genuinely distressed clients with malingering. So that's a crappy assessment. Now, listen, um, I love assessments, like I said earlier. So there is a um uh a need for assessments, but there is also a misuse of assessments. So over-reliance on those tools without clinical judgment, again, what did I say to you earlier? I put all of it together. I look for the story. What am I seeing so that I'm acutely aware of what I'm dealing with? So you have to, you know, you can't have an over-reliance on the tools, you know, like pathologizing our clients without clinical judgment. So that's why I use the assessments in my practice, not to pathologize, but to inform treatment, like I said, identifying inconsistencies and symptom presentation. And again, some tools are super effective, others not so much. So we have to know the difference. For example, I use the TAS-20, which is for alexathymia. Now, alexathymia is not common. There's um primary and secondary, I think they call it primary and secondary. Um, typically we see this on the autism um spectrum for primary. Sometimes we see it on secondary when we have like TBIs, that sort of thing. But what's interesting about the TAS20, what that tells me is not necessarily that um if they have a higher score about 50 or higher, not necessarily that they have a diagnosis of alexithymia, but what it does tell me is this individual has difficulty in articulating feelings. And and so I need to help them articulate this. And then if I go to the PID and see that they have higher levels of avoidance, that then it confirms what I thought. Okay, the task 20 is high, but they're not alexithymic. I'm not seeing anything else there. But the PID is showing that they have tendency towards avoidance and withdrawal. Ah, so that then informs, gosh, okay, this person has a really difficult time in tuning into what their feelings are and articulating them outwards. So that's what I help them with. And that's where the cool stuff that I learned with neuroscience is like, okay, we've got to step into waking up the insula of the brain. We need to work on this. Maybe they're working really hard with that prefrontal cortex and downplaying the insula, which allows us to know what's going on within our internal environment. And maybe um it helps tamp down the amygdala because they've experienced some pretty um high flight or fight situations. Who knows? But again, it's part of the narrative. It helps me see the whole person. So some tools are effective, and some are like, you know, they're okay. The task 20, I'm not, I'm not diagnosing with alexithymia, but it is informing what I am seeing and where do I need to help them? So assessments are just are just one tool, right, in a clinician's toolbox. And so they shouldn't really, they should not ever replace careful observation and professional discernment. So, wrapping all of this up, I I know I've kind of gone all over the place. Therapy should challenge our clients, not affirm them. Please hear this from me. I am so sick of my industry affirming every single ailment. Um, I say this all the time to my clients. I love what I do with all of my heart and soul. Like I love it so much. I hate my industry and what it's become. We're not here to affirm the distress you're in. You're coming to me to change. So let's change. So, true empathy, it is not in coddling. You have to understand this. True empathy is not in coddling, it's in guiding our clients towards personal accountability. I mean, seriously. So the mental health field, we have to move away from the symptom affirmation and towards resilience building. Come on. And if we're seeing feigning, whether it's malingering, whether it's um fictitious, or whether it's just kind of an unconscious feigning, okay, so step into it. Set your discomfort aside and your fears of what if they attack me. Okay, they attack you. All right, buck up, camper. This is a tough profession. You're gonna be okay. But you need to have direct conversation with your clients because if they're feigning and then you step into a treatment in an application, a therapeutic application, shame on you. Because you are going to cause them harm because you're too chicken to possibly get yelled at by your client. We have to be aware of these things. And again, you know, we have to ask ourselves: are we helping our clients heal? Are we enabling distorted narratives? Why are you a therapist? I get you love people and you want to take care of their hearts. I get that, me too. I love my clients, I do, but I am not here to sustain the distress that they're feeling. What the heck am I doing if that's what I'm doing in this field? This is so backward. It is, I mean, like all of the psychological greats are like rolling over in their grave right now. Like, what is wrong with you people? That's not our job. What we need to do is we have got to directly confront those distortive, those distorted narratives. So let me ask you this: what does true effective therapy look like in the face of societal pressures to validate everything? And are you stepping into validating feigning because you are fearful of potential outcomes with your client? Gotta look at this. You gotta look at this. So thanks for joining me today. A lot of conversation here, a little bit on my pedestal. But I do think it's very important that we acknowledge that feigning can take place and most of the time it's it's unconscious, but it is a really awesome opportunity as clinicians to say, hey, let me step with you into self-worth and life skills. I want to build you up rather than go along with the distress, and it's not even there. It's not even there. So thanks again for joining me. I would love to hear your thoughts on this. I'm sure I uh bristled a few of you, but that's all right. Because I'm not in this business to affirm your feelings. I'm in this business to challenge you. Take care. That's it for today's episode. Thanks for tuning in. I hope you're walking away with tools and insights to untangle your mind and take meaningful steps in your life. If you're ready to work with me on anxiety, trauma, or grief, please visit my website at untangledmind.net to learn more and connect. And if you found this episode helpful, I'd love for you to rate and review the show on your favorite podcast platform and share it with those who might benefit. Thanks so much for listening to Untangled Mind Podcast. I'm Piper Harris, and I'll catch you next time.